PROJECT SUMMARY Although much research has been conducted on the impact of the electronic health record (EHR) and health information technology (HIT) on provider-patient interaction, challenges persist on how to effectively integrate these tools into healthcare environments, while maintaining patient-centered care. We propose a multi-method study to investigate and improve the exam room and computing layout to improve clinical workflow and patient-centeredness, which may ultimately enhance patient safety, in the Veterans Health Administration (VHA). The Specific Aims are: Aim 1: Prototype and evaluate a redesigned exam room layout with respect to the exam room computing and compare the redesigned layout to a current, typical exam room layout in the Veterans Health Administration (VHA). Aim 2: Refine the redesigned exam room layout, implement it in a live clinic setting, and compare it to currently designed exam rooms in a Veterans Affairs (VA) Medical Center. To achieve Aim 1, we propose a ?human in the loop? simulation study in the Center for Ergonomics laboratory space at the University of Louisville to pilot test a redesigned exam room layout with respect to the exam room computing. In the proposed simulation study, improved system design can be demonstrated through measures of efficiency, accuracy, workload, patient-centeredness, time spent screen sharing, workflow integration, and situation awareness. Each of these measures will be used to compare a current, typical exam room layout with the redesigned layout in a simulated setting. To achieve Aim 2, we propose a pilot implementation based upon actual patient visits in a live clinic. We will collect measures of patient-centeredness, screen sharing, workflow integration, and situation awareness in both the redesigned exam room and current exam rooms to understand the impact of the redesigned exam room layout. The intention of the live clinic study is to gather additional field data to support the findings from the laboratory simulation study, and ultimately to have confidence our intervention for a larger study that would support broad dissemination of the redesigned exam room layout VHA-wide. Through these aims, we will refine and finalize a new exam room design for the VHA grounded in a sociotechnical systems perspective. We expect the knowledge generated by this study will be generalizable across different healthcare organizations for enhancing patient-centeredness with regard to exam room computing.